Lipid Rescue

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Lipid Rescue

• Treatment for Local Anesthetic-Induced Cardiac
  Arrest

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Current Data

• 20 out of 10,000 peripheral nerve blocks
• 4 out of 10,000 epidural block
• Result in systemic local toxicity requiring
  treatment!

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www.lipidrescue.org

• For more information on local toxicity

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Initial symptoms of Local Anesthetic Overdose

• Mild hypertension
• Tachycardia
• Mild Agitation
• Confusion

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Cardiac Toxicity

• Hypotension
• Atrioventricular Conduction Delay
• Idioventricular Rhythms
• Respiratory Depression
• Cardiovascular Collapse

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Local Anesthetic Toxicity

• Can Occur after Ingestion
• IV Administration
• Topical Application

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2 proposed methods of How Intralipids Work

• 1stThe lipid infusion creates a lipid phase, or
  lipid sink, in the plasma to which local
  anesthetics can partition into.
• The 2nd possible mechanism is reversal of
  mitochondrial fatty acid transport inhibition. It
  is believed that local anesthetics inhibit
  carnitine acylcarnitine translocase (CACT), an
  enzyme used in mitochondrial fatty acid
  metabolism and transport. Because fatty acids are
  involved in 80 to 90 of cardiac adenosine
  5'-triphosphate (ATP) synthesis, inhibition of
  CACT may contribute to cardiac toxicity. Lipid
  infusion may increase the intracellular fatty
  acid content enough to overcome the inhibition of
  the CACT enzyme by the anesthetic.

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Conclusions

• Lipid infusion appears to reverse cardiotoxicity
  rapidly, is easier than cardiopulmonary bypass.
• Lipid emulsion is readily available at a much
  lower cost.
• Lipid rescue therapy is to be reserved until ACLS
  procedures have been unsuccessful in cases of
  local anesthetic toxicity.